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Costs and effects of ultrasonography in the evaluation of palpable breast masses

Published online by Cambridge University Press:  01 November 2004

Karin Flobbe ,
Alfons G. H. Kessels ,
Johan L. Severens ,
Geerard L. Beets ,
Harry J. de Koning ,
Maarten F. von Meyenfeldt  and
Jos M. A. van Engelshoven
Karin Flobbe
Affiliation:
Maastricht University Hospital
Alfons G. H. Kessels
Affiliation:
Maastricht University Hospital
Johan L. Severens
Affiliation:
Maastricht University Hospital Maastricht University
Geerard L. Beets
Affiliation:
Maastricht University Hospital
Harry J. de Koning
Affiliation:
Erasmus University Medical Center
Maarten F. von Meyenfeldt
Affiliation:
Maastricht University Hospital
Jos M. A. van Engelshoven
Affiliation:
Maastricht University Hospital
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Abstract

Objective: To study the costs and effects of incorporating ultrasonography in the triple assessment of palpable breast masses.

Methods: A decision analytic model was designed to compare a conventional strategy of performing fine-needle aspiration cytology after clinical examination and mammography, with three different experimental strategies of preceding ultrasonography. Empirical data were used from a prospective study in 522 breasts in 492 patients with a palpable mass, including 93 malignancies. In strategy 1, cases with probably benign, suspect malignant, and malignant ultrasonography results were referred for fine-needle aspiration cytology; in strategy 2, benign cases were also referred for fine-needle aspiration cytology; and in strategy 3, ultrasonography was only performed in patients with benign results on clinical examination and mammography, whereas immediate fine-needle aspiration cytology was performed in patients with suspicious lesions. Outcome variables included the total costs and the expected number of life years. Sensitivity analysis was performed on all parameters in the model.

Results: All strategies reported a similar life expectancy of 31.0 years. Cost-minimization demonstrated that experimental strategy 3 was the least expensive strategy (€ 3,013). Experimental strategy 2 was the most costly one (€ 3,512). Compared with the conventional strategy of immediate fine-needle aspiration cytology (€ 3,087), both ultrasonography strategies 1 and −3 were preferred.

Conclusions: Incorporating ultrasonography in the triple assessment of palpable breast masses can result in a reduction of the total costs for the diagnosis and treatment of breast cancer.

Keywords

Diagnostic imagingUltrasonographyBreast neoplasmsCost-effectiveness
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 4 , November 2004 , pp. 440 - 448
Copyright
© 2004 Cambridge University Press

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References

American College of Radiology. 1995. Assessment categories: Illustrated breast imaging reporting and data system (Illustrated BI-RADS). Reston, VA: American College of Radiology;
2000: Behandelingsrichtlijnen radiotherapie van het operabele mammacarcinoom na mamma-amputatie en okselkliertoilet in Nederland. Landelijk Platform voor Radiotherapie en Mammacarcinoom (LPRM) en NABON; 1– 13.
2000. Farmacotherapeutisch Kompas 2000/2001: medisch farmaceutische voorlichting. Amstelveen: College voor Zorgverzekeringen;
1999: Richtlijn diagnostiek en behandeling van primair mammacarcinoom. Maastricht: Integraal Kankercentrum Limburg; 1– 66.
Agarwal T, Patel B, Rajan P, et al. 2003 Core biopsy versus FNAC for palpable breast cancers. Is image guidance necessary? Eur J Cancer. 39: 52– 56.Google Scholar
Ciatto S, Cariaggi P, Bulgaresi P. 1987 The value of routine cytologic examination of breast cyst fluids. Acta Cytol. 31: 301– 304.Google Scholar
de Koning HJ, van Ineveld BM, de Haes JC, et al. 1992 Advanced breast cancer and its prevention by screening. Br J Cancer. 65: 950– 955.Google Scholar
de Koning HJ, van Ineveld BM, van Ootmarssen GJ, et al. 1990: De kosten en effecten van bevolkingsonderzoek naar borstkanker. Eindrapport Kosten-effectiviteits Analyse. Rotterdam: Instituut Maatschappelijke Gezondheidszorg, Erasmus Universiteit Rotterdam; 1– 194.
Dey P, Bundred N, Gibbs A, et al. 2002 Costs and benefits of a one stop clinic compared with a dedicated breast clinic: Randomised controlled trial. BMJ. 324: 507.Google Scholar
Eltahir A, Jibril JA, Squair J, et al. 1999 The accuracy of “one-stop” diagnosis for 1,110 patients presenting to a symptomatic breast clinic. J R Coll Surg Edinb. 44: 226– 230.Google Scholar
Flobbe K, Bosch AM, Kessels AG, et al. 2003 The additional diagnostic value of ultrasonography in the diagnosis of breast cancer. Arch Intern Med. 163: 1194– 1199.Google Scholar
Freedman GM, Fowble BL. 2000 Local recurrence after mastectomy or breast-conserving surgery and radiation. Oncology (Huntingt). 14: 1561– 1581; discussion 1581–1582, 1582–1584.Google Scholar
Gui GP, Allum WH, Perry NM, et al. 1995 One-stop diagnosis for symptomatic breast disease. Ann R Coll Surg Engl. 77: 24– 27.Google Scholar
Hardy JR, Powles TJ, Judson I, et al. 1990 How many tests are required in the diagnosis of palpable breast abnormalities? Clin Oncol (R Coll Radiol). 2: 148– 152.Google Scholar
Hermansen C, Skovgaard Poulsen H, Jensen J, et al. 1987 Diagnostic reliability of combined physical examination, mammography, and fine-needle puncture (“triple-test”) in breast tumors. A prospective study. Cancer. 60: 1866– 1871.Google Scholar
Hurley SF, Huggins RM, Snyder RD, Bishop JF. 1992 The cost of breast cancer recurrences. Br J Cancer. 65: 449– 455.Google Scholar
Lister D, Evans AJ, Burrell HC, et al. 1998 The accuracy of breast ultrasound in the evaluation of clinically benign, symptomatic breast lumps. Clin Radiol. 53: 490– 492.Google Scholar
Mendelson EB, Berg WA, Merritt CR. 2001 Toward a standardized breast ultrasound lexicon, BI-RADS: Ultrasound. Semin Roentgenol. 36: 217– 225.Google Scholar
van Oord JC, van der Vliet AM, Thyn CJ, Mak B, Hoogeboom GJ. 1991 The value of ultrasound mammography in palpable breast masses. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 155: 63– 66.Google Scholar
Oostenbrink JB, Koopmanschap MA, Rutten FFH. 2000. Handleiding voor kostenonderzoek, methoden en richtlijnen voor economische evaluaties in de gezondheidszorg. Amstelveen: College voor Zorgverzekeringen;
Perre CI, de Hooge P, Hustinx PA, Muller JW. 1993 [Ultrasonographic study of the palpable breast tumor is very useful]. Ned Tijdschr Geneeskd. 137: 2374– 2377.Google Scholar
Richards MA, Braysher S, Gregory WM, Rubens RD. 1993 Advanced breast cancer: Use of resources and cost implications. Br J Cancer. 67: 856– 860.Google Scholar
Sakorafas GH, Tsiotou AG. 2000 Selection criteria for breast conservation in breast cancer. Eur J Surg. 166: 835– 846.Google Scholar
Slotman BJ, Levendag PC, Botke G, Leer JWH. 2000 Producttypering in de radiotherapie. Medisch Contact. 55: 1198– 1201.Google Scholar
van Tienhoven G, Voogd AC, Peterse JL, et al. 1999 Prognosis after treatment for loco-regional recurrence after mastectomy or breast conserving therapy in two randomised trials (EORTC 10801 and DBCG-82TM). EORTC Breast Cancer Cooperative Group and the Danish Breast Cancer Cooperative Group. Eur J Cancer. 35: 32– 38.Google Scholar
Vetto J, Pommier R, Schmidt W, et al. 1995 Use of the “triple test” for palpable breast lesions yields high diagnostic accuracy and cost savings. Am J Surg. 169: 519– 522.Google Scholar
Will BP, Berthelot JM, Le Petit C, et al. 2000 Estimates of the lifetime costs of breast cancer treatment in Canada. Eur J Cancer. 36: 724– 735.Google Scholar
Yang WTY, Mok CO, King W, Tang A, Metreweli C. 1996 Role of high frequency ultrasonography in the evaluation of palpable breast masses in Chinese women. J Ultrasound Med. 15: 637– 644.Google Scholar